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PROOF OF INSURANCE (2015) CLOSEDAgreement No. 4596 Agreement No. 4597 Addscape, Inc. CERTIFICATE OF LIABILITY INSURANCE =DATI 0 720 R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the certificate holder in lieu of such endorsoment s, PRODUCER DAB WON INSURANCE SERVICES INC. PHONEFAS A �JEANNI E JUN..µ,., _�.. ✓..,.. �_NL_it rq�, 3 6 5-115 7 DIAEWONINS®YAHOO.COM 213m ^^-�V 3540 WILSHIRE BLVD I�°`" A_JC ..®' SUITE 505 �I .....-. _.. LOS ANGELES CA 90010 jNsURER A; --^mm -ERi3!AFL RL_c Aft ECOM.... _. NAIC a JAMBS RIVER INSURANCE PANY ADDSCAPE INC OLDEN EAGLE INSURANCE COMPANY rNSURrmR B TOP, INSURANCE COffP � ""° DBA: ALPHA OMEGA BUILDERS °NSUReR, -^ C -. 11723 S WESTERN AVE gHSwN rtr .STATE FUND - YNSORf,11't�. .._.... LOS ANGELES CA 901)47 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT„TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BY PAID CLAIMS. _LM R EXCLUSIONS AND CONDITIONS OF SUCH PPOO�LIICItES LIMITS SHOWN MAY HAVE BEEN REDUCED BY POLICY N -.-.-.,. .- ,.'.�_.jusa 18a F' POtaCY EXP ....�.____..,......... -.........NUMBER 1q'wo MM�OOC,V LIMITS 43ENERAL LIABILITY 00061614-0 03/25/2014 03/25/2015. EACH OCCURRENCE S 00 COMMERCIAL COMMERCIAL GENERAL LIABILITY wRrp�usl s� S 50 000 . �CLAIMS-MADE Z OCCUR MEDE;KP(Aaa one ersoeu.,mm .. mEXCLUDED A .... ........ ....... X X PER'SONAl..3 ADV'INJURY S ._.1...!„000.. „ „0 0 Q rIL—AGGREGATE LIMN t `_S' D GENERALAO4"REGATE ,fi0'0 OQ TAPPLIESPER. ..... ACs�a S 2 Dot} 000 P'R'O. PRODUCTS•COMP/OP� ,..... r +.mm.,,mm . POLICY LOC g AUTOMOBILE LIABILITY ^m.M I tlN L I,F -- 02CE23184210 04/28/14 04/28/15 oar rrcur' f �0 ANY AUTO B DILY INJURY Per arson) S B ALL OWNED SCHEDULED x g —•- ( person) AUTOS AUTOS BODILY INJURY(Peractldent) $ NON-0WNED .. .�................... .,,,_. HIREDAUTOS AUTOS R'O RTY•O'AMA $ $ UMBRELLALIAB OCCUR TBF 05/30/14 03/25/15 ACHCCCJER, iwNCE.. S 2 00'0. I ImiO (' m... EXCESS LIA,,,._ CLAIMS-MADE "-` WC STA .... ... .-.....n_.......... OE'D RETENTIONS _ S WORKERS COMPENSATION TU OTH D OFFICERNEMB EXCLUDED?ECUTIVE .NIA ][ / / E•L,..E/Nf`H�A ,'„p'�JEr!p 7..,mm.. $ ....," V Q Q IT D... AND EMPLOYERS'LIABILITY 903-9877-2014 O1 01 14.01/01/15 _YIN 00 {MIYP4ddtesexin and E..I.. DISEASE-EAFMPLOYE S 1 Ofl'C(. 000 1IyyOS dascrll�lua!ndwar ..... .. 0 RIPTIONOFOPERATIONS beloow E_L,DISEASE'•M.ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,R more space Is required) (1) 2013-2014 CURB, GUTTER, SIDEWALK, AND OTHER CONCRETE IMPROVEMENTS PROJECT PROJECT NO. PW 13-22 : $43,780.300 (2) ADA RAMP INSTALLATION PROJECT PROJECT NO. : PW 13-14 COMMUNITY DEVELOPMENT BLOCK GRANT CDBG PROJECT NO. : 601608-13 $38,500.00 CERTIFICATE HOLDER CANCELLATION CITY CLERK " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: C" ADDITIONAL REMARKS SCHEDULE _ Page 2 of 2 AGENCY NAMEDINSURED DAE WON INSURANCE SERVICES, INC. ADDSCAPE INC POUCY NUMBER DBA : ALPHA OMEGA BUILDERS 00061614-0 11723 S WESTERN AVE CARRIER NAIC CODE LOS ANGELES CA 90047 JAMES RIVER INSURANCE COMPANY EFFEcTnre DATE:03/25/2014 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:. The Cit y, its officers, officials, employees, agents, and volunteers will be covered as insureds as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, occupied or used by the Contractor; or automobiles owned, leased, hired or borrowed by the Contractor. The coverage will contain no special limitations on the scope or protection afforded to the City, its officers, officials, employees, agents, or volunteers. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:00061614-0 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE - Name Of Additional Insured Person(s) —Or Omanization(s): Location(s)Of Covered Operations City of El Segundo PW13-14& 13-22 El Segundo, CA City Clerk's office 350 Main St El Segundo, CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds,the following additional exclu- organization(s)shown in the Schedule, but only sions apply: with respect to liability for"bodily injury","property This insurance does not apply to"bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs)to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s)at the location of the the additional insured(s) at the location(s)desig- covered operations has been completed;or nated above. 2. That portion of"your work"out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ POLICY NUMBER: 00061614-0 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s): tions City of El Segundo PW13-14& 13-22 El Segundo, CA City Clerk's office 350 Main St El Segundo, CA 90245 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section Il—Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, but only with respect to liability for"bodily injury"or "property damage"caused, in whole or in part, by"your work"at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the"products-completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ POLICY NUMBER:00061614-0 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of El Segundo City Clerk's office 350 Main St El Segundo, CA 90245 Information required to complete this Schedule, if not shown alcove,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of We waive any right of recovery we may have against Rights Of Recovery Against Others To Us of the pe rson o r o rganization sho wn i n t he S chedule Section IV—Conditions: above be cause of paym ents we ma ke for injury o r damage a rising o ut of yo ur ongoing operations o r "your wo rk"d one and er a contract with that perso n or organi zation and in cluded in the "produ cts- completed operations hazard".This waiver applies only to the person or organi zation shown in th e Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS W Name Of Additional Insured Person(s) _.. Or Organization(s): City of El Segundo City Clerk's office 350 Main St El Segundo, CA 90245 If no entry appears above,this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US 04-10 Page 1 of 1 . . �REPmwEDmOM THE FORMS LIBRARv� COMMERCIAL AUTO CA7110O3O7 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect 1ocoverage provided by this endomamoru, the provisions of the Coverage Form apply unless modified by the endorsement. EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2'b. of the CANCELLATION Common SECTION U — LIABILITY COVERAGE — A.I. WHO Policy Condition is replaced by the following: IS AN INSURED provision is amended by the addition b. UV days before the n�nc� � date of cancellation of the following: if*o cancel for any other reason. e' Any person or organization for whom you are re- quired by an Insured contract" to provide insu, TEMPORMRY SUBSTITUTE AUTO — PHYSICAL anoe is an 'inuunod'', subject to the following DAMAGE COVERAGE additional provisions: (1) The 'insured contract" must be in effect Undar paragraph �. — CERTAIN TRAILERS, �O' BILE EQUIPMENT AND TEMPORARY SUBSTITUTE during the policy period shown in the Deo|o' AUTOG of SECTION 1 — COVERED AUTOS, rations, and must have been executed prior' ��m following ivadded: to the "bodily injury" or "property damage". (2) This person nr organization iuon "insured" If Physical Damage coverage is provided by this Cm~ only to the ex1nru you are Uob|m due to your omgeFunn. then you have coverage for: ongoing operations for that insured,whether the work|o performed by you or for you, and Any ^oum^ you do not own while used with the per- only tothe extent you are hu|U liable for an mission of its owner as o temporary substitute for a "accident" onourhng while ucovered "auto" covered ~uu*o" you own that is out of xomioe be' is being driven by you or one of your em- cause of its bmukdown, repair, servicing, "loss" or p|oynas. destruction. (3) Thom is no coverage provided to this person or organization for "bodily injury" m its em- BROAD FORM NAMED INSURED p|oyoeo. nor for "property damage" to its SECTION U — L|A8|LITY COVERAGE — A'1. WHO property. IS AN INSURED provision is amended by the addition (/) Coverage for this person or organization nf the following: ohoU be limited to the extent of your negli- gence or fault according to the applicable d. Any business entity newly acquired orformed by principles of comparative negligence orfault. you during the policy period provided you own `5) The defense uf any claim or "suit" must be oU�� or more of the business entity and the business entity is not separately insured for tendered by this person or organization u» Duoinono Auto Coverage. Coverage is extended soon as pnuc\ioob|a �u all other insurers which potentially insurance up to a maximum of 180 days following ooqu|oi' y p n|a/mo, ^ovit'' hono,fnnne�nnof the business on8 �entity. ' under this provision is afforded only until the end of the policy period. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services O#oo. Inc., 1897 CA n m mm Page 1 01 sp REPRINTED FROM THE FORMS LIBRARY'°' (6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION III — PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy; AGE, A.4. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. Personal Effects Coverage the 'Insured contract". For any Owned "auto" that is involved in a (7) A person's or organization's status as an covered `loss", we will pay up to $500 for 'insured" under this subparagraph d ends "personal effects" that are lost or damaged when your operations for that 'Insured" are as a result of the covered "loss", without completed. applying a deductible. EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A.of Section II — LIABILITY COV- Paragraph A. — COVERAGE of SECTION III — ERAGE item f. is added as follows: PHYSICAL DAMAGE COVERAGE is amended to add: Your "employee" while using his owned "auto", or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen in your business or your personal affairs, provided you covered "auto"to you. do not own, hire or borrow that "auto". This coverage is excess to any other collectible insurance coverage. AIRBAG COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is Exclusion 5. FELLOW EMPLOYEE of SECTION Il — added: LIABILITY COVERAGE — B. EXCLUSIONS is amended by the addition of the following: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However, this exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMIT OF INSURANCE of collectible insurance. Section III — PHYSICAL DAMAGE COVERAGE sec- tion 2 is amended as follows: BLANKET WAIVER OF SUBROGATION 2. An adjustment for depreciation and physical con- We waive the right of recovery we may have for pay- dition will be made in determining actual cash ments made for "bodily injury" or "property damage" value in the event of a total loss. However, in the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to 'insureds" under Section II —LIABILITY COVERAGE which this coverage applies, as shown in the — A.1.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option: A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price you paid for your damaged vehicle, not in- PHYSICAL DAMAGE — ADDITIONAL TRANS- cluding any insurance or warranties pur- PORTATION EXPENSE COVERAGE chased; The first sentence of paragraph A.4. of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make, model and follows: equipment, not including any furnishings, parts or equipment not installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership. $1,500 for temporary transportation expense incurred If the same model is not available pay the by you because of the total theft of a covered "auto" purchase price of the most similar model of the private passenger type. available; Page 2 of 6 REPRINTED FROM THE FORMS LIBRARY"" c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings, parts or equip- property as of the time of the "loss", less an ment not installed by the manufacturer or adjustment for depreciation and physical manufacturer's dealership. condition; or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" is truck type (20,000 Ibs or less gross vehicle subject to at the time of the 'loss", less any weight) and does not apply to initiation or set up one or all of the following adjustments: costs associated with loans or leases. (1) Overdue payment and financial TWO OR MORE DEDUCTIBLES penalties associated with those payments as of the date of the Under SECTION III — PHYSICAL DAMAGE COV- "loss". ERAGE, if two or more "company" policies or cover- (2) Financial penalties imposed under a age forms apply to the same accident, the following lease due to high mileage, exces- applies to paragraph D. Deductible: sive use or abnormal wear and tear. a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre- ible is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident ible it will be waived; or or Disability Insurance purchased b. If the applicable Business Auto deduct- with the loan or lease. ible is not the smaller (or smallest) de- (4) Transfer or rollover balances from ductible it will be reduced by the amount previous loans or leases. of the smaller (or smallest) deductible; (5) Final payment due under a "Balloon or Loan". c. If the loss involves two or more Busi- (6) The dollar amount of any ness Auto coverage forms or policies un-repaired damage that occurred the smaller (or smallest) deductible will prior to the "total loss"of a covered be waived. "auto". For the purpose of this endorsement (7) Security deposits not refunded by a "company" means: lessor. a. Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination c. General Insurance Company of America of a lease agreement or any war- ranty or extended service agree- d. American Economy Insurance Company ment on a covered "auto". e. First National Insurance Company of (9) Any amount representing taxes. America (10) Loan or lease termination fees f. American States Insurance Company of Texas GLASS REPAIR — WAIVER OF DEDUCTIBLE g. American States Preferred Insurance Under paragraph D. — DEDUCTIBLE of SECTION III Company — PHYSICAL DAMAGE COVERAGE, the following is h. Safeco Insurance Company of Illinois added: LOAN/LEASE GAP COVERAGE No deductible applies to glass damage if the glass is repaired rather than replaced. Under paragraph C — LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI- the following is added: DENT, CLAIM, SUIT OR LOSS 4. The most we will pay for a total "loss" in any one The requirement in LOSS CONDITION 2.a. — "accident" is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a $1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS AUTO CONDITIONS that you must notify us of an CA 71 10 03 07 Page 3 of 6 EP - —REPRINTED FROM THE FORMSuBRAm- "aooidert"apdieaonlywhontho ~accidert^ isknown deductible and exoame pmvaiunn, we will provide m: coverage equal to the broadest coverage applicable to any covered ^uuho^ you own. (1) You, if you am an individual; N���� �Un� PM����AL04���� ����R&�� (2) A partner, �you are a partnership; or — LOSS OFUSE (3) An executive officer or insurance manoger, if you are ocorporation. SECTION U| — PHYSICAL DAMAGE A'4.b. Form does not apply. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Subject too maximum of$1.0U0 per accident, wewill cover |usu of use of a hired ^uuto" if it results from SECTION >V — BUSINESS AUTO CONDITIONS _ an accident, you are legally liable and the lessor in' 13.2' ix amended by the addition of the following: nvm an actual financial |uoo. If you unintentionally fail to d|uo|ooe any hozo0uex' RENTAL REIMBURSEMENT COVERAGE isting at the inception date of your po|iuy, we will not deny coverage under this Coverage Fnnn because of �' »V« will pay for rental reimbursement expenses be- such failure. However, this provision does not affect incurred by you for the ron�o| c� an ~ou»o^ ouun� of uoovemd lnso' oonoovnro� "auto".right to collect additional premium or exercise our ,igh�o�nonueUaUon ornon',nnnwu|� payme»t uPP|ieo in addition to the otherwise ap' p|ioob|e amount of each onvnrugo you have onu MIRED AUTO — LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this AGE coverage. B. We will pay only for those expenses incurred Under Section |n — 8uoin000 CondiUono, Paragraph during the policy period beginning 24 hours after B.7.b.e(1) is replaced by the following: the loss" and ending. regardless of the policy's (1) The ^oocidmn1" or "loss" muuUo expiration, with the lesser uf the following number from the use of an ^uutn^ hired for of days: 30 days or less. 1. The number of days reasonably required to repair or replace the covered "auto". If RESULTANT MENTAL ANGUISH COVERAGE "luxo^ is neumod by thnft, this number of days ia added tu the number vf days ittakes GB3|ON V — DEFINITIONS — C. is replaced by the to |mca10 the covered "auto" and return it to following: you. "Bodily injury" means bodily injury, sickness or db' 2. 30 days. ease sustained byaperson including mental anguish C Our payment in limited to the |none, of the fo|' or death resulting from any ofthese ' � lowing amounts: HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses incurred. � u5V per' . *rage and U Compmhenaivo, Specified Causes of D. This coverage Uueo not apply while there are Loss or Collision coverages are provided under this spare o,reserve ^autoy^ available to you for your Coverage Form for any "auto" you mwn, then the operations. Physical Damage Coverages provided are extended to ^uutuo" you hire or borrow. E. If 1000" results from the total theft of ucovomd ~auto^ uf the private passenger type, wn will pay The most we will pay for loss to any hired "auto" is under this coverage only that amount of your $50,000 or ^umu\ Cash Value or Coot of Repair, rental reimbursement expenses which is not al- whichever is amaUeut, minus u deductible. The de' ready provided for under the PHYSICAL DAM' duoUb|ewiU be equal to the largest deductible app|i' AGE COVERAGE Coverage Extension. cable to any owned ^nuto'' uf the private passenger or light truck type for that coverage. Hired Auto phy' F. The Rental Reimbursement Coverage described oicu| Damage coverage im excess over any other col- above does not apply toa covered ^au\o^that io donn �od or designated anaoovo,oU ^ovuo~ on |e'�iWn insurance. Subject to the above limit, described Page 4mu REPRINTED FROM THE FORMS LIBRARY"" Rental Reimbursement Coverage Form the manufacturer for the installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- A. Coverage SURANCE provision of PHYSICAL DAMAGE COVERAGE is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for "loss" to audio, vi- for 'loss" to any electronic equipment that sual or data electronic equipment and any receives or transmits audio, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one "accident" is the lesser of: reproduction of sound.This coverage applies only if the equipment is permanently installed a. The actual cash value of the damaged in the covered "auto" at the time of the or stolen property as of the time of the 'loss" or the equipment is removable from a "loss"; or housing unit which is permanently installed b. The cost of repairing or replacing the in the covered "auto" at the time of the damaged or stolen property with other loss", and such equipment is designed to property of like kind and quality. be solely operated by use of the power from the "auto's"electrical system, in or upon the c. $1,000. covered "auto". 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered "auto" condition will be made in determining actual for "loss" to any accessories used with the cash value at the time of the loss". electronic equipment described in paragraph 3. If a repair or replacement results in better A.I. above. than like kind or quality, we will not pay for However, this does not include tapes, the amount of the betterment. records or discs. 3. if Audio, Visual and Data Electronic Equip- D. Deductible ment Coverage form CA 99 60 or CA 99 94 1. If "loss" to the audio, visual or data elec- is attached to this policy, then the Audio, Vi- tronic equipment or accessories used with sual and Data Electronic Equipment Cover- this equipment is the result of a loss"to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehensive or Colli- B. Exclusions sion Coverage, then for each covered "auto" The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or re- AGE COVERAGE, except for the exclusion relat- place damaged or stolen property will be re- ing to Audio, Visual and Data Electronic duced by the applicable deductible shown in Equipment, also apply to this coverage. In addi- the Declarations. Any Comprehensive Cov- tion, the following exclusions apply: erage deductible shown in the Declarations does not apply to "loss" to audio, visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or ment or accessories used with such electronic lightning. equipment that is: 2. If loss" to the audio, visual or data elec- 1. Necessary for the normal operation of the tronic equipment or accessories used with covered "auto" for the monitoring of the this equipment is the result of a 'loss"to the covered "auto's" operating system; or covered "auto" under the Business Auto 2. Both: Coverage Form's Specified Causes of Loss Coverage, then for each covered "auto" our a. an integral part of the same unit housing obligation to pay for, repair, return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a$100 deductible. sound if the sound reproducing 3. If "loss" occurs solely to the audio,visual or equipment is permanently installed in data electronic equipment or accessories the covered "auto"; and used with this equipment, then for each cov- b, permanently installed in the opening of ered "auto" our obligation to pay for, repair, the dash or console normally used by CA 71 10 03 07 Page 5 of 6 EP REPRINTEDFROM THE FORMS LIBRARY return or replace damaged or stolen property SECTION V — DEFINITIONS is amended by adding will be reduced by a$100 deductible. the following: 4. In the event that there is more than one ap- Q. "Personal effects" means your tangible plicable deductible, only the highest deduct- property that is worn or carried by you, ex- ible will apply. In no event will more than one cept for tools,jewelry, money, or securities. deductible apply. R. "New vehicle" means any "auto" of which you are the original owner and the "auto" has not been previously titled and is less than 365 days past the purchase date. Page 6 of 6 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION • 9039877-14 RENEWAL SC 5-49-16-10 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE MAY 13, 2014 AT 12 .01 A.M. ALLEFFECTIVE DATESARE AND EXPIRING JANUARY 1, 2015 AT 12.01 A.M. AT 1201 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ALPHA OMEGA BUILDERS 11723 S WESTERN AVE LOS ANGELES, CA 90047 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, ALPHA OMEGA BUILDERS IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAWN FRANCISCO: MAY 15, 2014 2570 j v - 4 , �;I./ (14KU,. F4, AUTHORIZED REPRESENT: IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.1-20121 OLD DP 217